ECS

ELECTRONIC CLEARING SERVICE (CREDIT CLEARING)

MANDATE FORM

Shareholder's authorization to receive dividends through Electronic Credit Clearing Mechanism

• 1. Name of the first/sole shareholder :
• 2. Folio no. / Client ID no. :
• 3. Particulars of Bank account of first/ sole shareholder
• a) Name of the Bank :
• b) Branch, Address, Telephone no. of the branch :
• c) 9 digit code number of the Bank and branch appearing on the MICR cheque :
Issued by the Bank
• d) Account number :
(as appearing on the cheque book/passbook)
• e) Account type:
(S.B. account/current account or cash credit) : with code 10/11/13
• f) Ledger no. / Ledger folio no. :
(If appearing on the cheque book/pass book)

(In lieu of the bank certificate to be obtained as under, please attach a blank cancelled cheque, or photocopy of a cheque or the front page of the savings bank passbook issued by your bank, for verification of the above particulars).

I hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I will not hold Suven Pharmaceuticals Ltd. responsible. I agree to discharge the responsibility expected Place: Date: Signature of the Shareholder Certified that the particulars furnished above are correct as per our records Banks Stamp Date: Signature of Authorized Official of the Bank